HomeMy WebLinkAbout0024 KINGS WAY - Health 24 King's Way
r Hyannis
` A= 328-008
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Mar 12 13 05: 25p John Lyons 508-778-2276 p. l
Depamnent of Public Health-Childhood Lead Poisoning Prevention Program
Deleadiing Notification
Please complete All sections of this form etenrly.Incomplete or illegible forma will be returned.
Lead Paint Inspector Paula Prior License a 3985 Inspection Datc 2128/13,
Pr9perty Owner Maria A.Pacheco
Property Owner's A 4 I<irigs V�ay F1ynnis Ma Zip Code 02601
Authorizcd person performing work: John P,Lyons Lic#lAuth.9 001912
Address of authorized person.72 Higgins Crowell Rd. W-Yarmouth Ma Zip Code 02673
Telephone Number 7(�74) 353.62ff5
Address whctr the work will be done:
Building Name(irany) Floot
Strcet Address 4 Kings ay _ Apt No.
Cityir?nis Ma._._ - zip Cadc DZ60" •-,fie property is a_multi-fa,nily X single family-
Weadinh Mcthod(�1
o Making paint intact(high risk) o Making paint intact(moderate O Applying vinyl siding on exterior
Q Demolition rise) 4 Component removal(low risk
QY Scraping o Liquid cncapsulant components)
0 Component femoval/replacammt 0 Covering a Other:
-
a Dipping o Capping baseboards
The work will begin on 3l 31_„-and will Cmish by4 4 /13 The work will be done in the_ant__pm or X weekends,
In Case ofEmerggencv Contact John P. Lyons
Daytime Phone 774-252-6235 Evening Phone 50B-775-4066
The Property Owner most complete and sign the following information;
I certify that only authorized pemns who have complied with flee training requirements of the Mamchusctts Lcad Poisoning
Prevention and Control Rcgulations, 105 CMR 460.000,will conduct deleading work.I further certify that the authorized
person(s)will not exceed the scope of his/her authori and will be performing only those activities indicatcd above_All of the
information contained in this document is true and c to the best of nowledge and belief.
Date 3/5/2013 - - Signed X-1--
The following lmopletagencies must be trb'tied ten days before beginning work: �
1, Occupants of the dweuing unit HONE
2. All other occupants of the residential premises,it any A9A will be done in the common areas N/A
3. Childhood Lcad Poisoning Prevcmion Program,DPH Fax(781)774700
MWRHO
5 Randolph Sireet,Canton.MA 02021
4. Asbestos and Lead Progruu.DLS
19 Staniford St, 13'Floor,Boston,MA 42114 Fax(617)620-6965
5, Local Board of HealthdCodc Enforcement Agency Barnstable Ma �a08- 9Q-6�300� cs' j(p
f f the home is on the Bute Rcginter of l listvric Plntxs,can the MA I liskxiud Commission at(617)727-R470.